When Arthritis Is a Pain in the Jaw

Temporomandibular disorder (TMD) may be a mouthful, but it simply stands for pain, stiffness, and other symptoms affecting the jaw, or temporomandibular joint (TMJ). One of the most common causes of TMD is arthritis—the same array of degenerative conditions that affect other joints, such as the knees, hips, and fingers.

Most often, the type of arthritis behind TMD is osteoarthritis, but there are others as well, including rheumatoid arthritis and spondyloarthropathies, such as ankylosing spondylitis. Here's an overview of each.

Osteoarthritis

Osteoarthritis usually develops over time due to wear and tear that causes bone and soft tissue to break down. Besides pain, osteoarthritis can cause a crunching sound that's known as crepitus in the joint and limited range of motion, making it hard to "open wide." This mostly happens in older people, according to the American Academy of Orofacial Pain (AAOP).

Most often, osteoarthritis of the temporomandibular joint is unilateral, meaning just one side of the face is affected.

To diagnose osteoarthritis-based TMD a doctor will take a medical history, consider specific symptoms, and perhaps do an MRI or use some other imaging technique. Treatment typically includes nonsteroidal anti-inflammatory drugs (NSAIDs), along with heat, a soft diet, limiting movement of the jaw, or a bite appliance. If these measures don't bring relief, surgery is sometimes needed.

Rheumatoid Arthritis

Although the jaw isn't the first of the joints affected by rheumatoid arthritis (RA), a form of joint pain that's caused by problems with the immune system, as many as 90% of people with RA may also have jaw pain. TMD that's caused by this type of arthritis tends to affect both sides of the face and also causes swelling, tenderness, and limited movement of the jaws. These symptoms tend to come and go, with stiffness and pain usually worse in the morning.

Besides symptoms and medical history, diagnosing RA as a cause of joint pain involves imaging studies and blood tests, and treatment is the same as for any joint affected by rheumatoid arthritis: anti-inflammatory drugs and disease-modifying anti-rheumatic drugs (DMARDs), plus exercises to prevent loss of motion in the jaw. Sometimes surgery is required.

Spondyloarthropathies

Spondyloarthropathies are types of arthritis that involve the areas where ligaments and tendons attach to bones. One of these is ankylosing spondylitis, which affects the back and neck and can cause pain and limited jaw movement.

Another is psoriatic arthritis, which has symptoms that mimic those of rheumatoid arthritis. There is a similar pain, tenderness, limited range of motion, and crepitus, although often only one jaw is involved. Reactive arthritis of the temporomandibular joint is the third type of spondyloarthropathy that's associated with TMD. Men are more likely than women to develop reactive arthritis , which causes pain, swelling, and limited range of motion of the jaw. Because it's triggered by an infection, an antibiotic is often part of the treatment.